The strategy behind this deal, announced in 2012, wasn't just about becoming bigger and having every medical service under one roof. It was about
And the deal worked well, so well that not long ago
Now the ACA could be going overboard, with no firm notion yet on what's most likely to replace it or even if huge government programs like
The merger, however, makes as much sense in
The merger of
While most of that sprawling legislation was about reshaping the health insurance market rather than how patients were treated by doctors and hospitals, the act contained provisions that looked like they could lead to fundamental changes in the way health care got paid for, in turn changing what doctors and hospitals did.
Suddenly a new term grew very popular, the so-called accountable care organization. It meant big providers would get paid based on how healthy they kept their patients rather than on how many checkups and medical procedures they did.
There was more than one reason for doing a merger, of course. But for a diversified health care provider like
Now that we're a few years into the implementation, however, only the health care trade press still writes about the potential of accountable care organizations. Everybody else is writing about insurance rates going through the roof in the individual health insurance market.
To Brainerd, this looks more like one more sign of the far bigger problem of how costly health care is. She remembers when the complaint she heard most from consumers was about bad service, like a long wait time to see a doctor.
"The most frequent thing I hear now from patients is 'I can't afford it,' " she said, with episodes like patients who are mad they had to pay for a medical test when the results showed there wasn't a problem. They had a big deductible to pay on their insurance plan, and the test cost a lot.
Among the many reasons health care cost increases have accelerated lately, Brainerd said, are higher prices for specialty drugs, surging orthopedic procedures as baby boomers age "and just a little more money going to the doctors."
The goal at
The total cost for the
Brainerd also shared a presentation slide on "affordability strategies." Many of the initiatives listed on this very busy slide were expected to save as little as
One of Brainerd's convictions is that no health care organization can talk about affordability if it doesn't also deliver high-quality care. There are initiatives that can meet both of these goals at the same time, of course. One recent example is beginning to screen for postpartum depression in a pediatrician's office, as a new mom is far more likely to visit a pediatrician with her new baby than her own doctor.
Now that national health care policy is up in the air again, some changes that would make the most sense to her don't seem much closer to becoming reality than they did eight years ago.
She described how one of her physicians continues to express frustration that simple consumer technologies like an iPhone can't be more widely used to monitor and consult with patients with chronic conditions, rather than asking them to keep coming into a clinic.
The problem, of course, is that providers still have a hard time figuring out the right way to get paid for the value of innovative smartphone monitoring but know exactly how to send a bill to an insurer for an office exam.
"Repeal, replace, modify it, I don't care what they call it," she said, of federal health care policy, "just so long as we start figuring some things out."
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